Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study

Main Article Content

Dion Darius Samsudin
Agus Firmansyah
Eka Laksmi Hidayati
Irene Yuniar
Mulya Rahma Karyanti
Rosalina Dewi Roeslani

Abstract

Background Acute diarrhea is a common health problem in Indonesia. During acute diarrhea, changes in gut microbiota are marked by decrease beneficial microbes Bifidobacterium and Lactobacillus, and increased pathogenic bacteria Enterobacter and Clostridium. Such microbial imbalances are known as dysbiosis. Treatment with probiotics may help repair dysbiosis, quicken healing time, and decrease complications.


Objective To assess for dysbiosis during acute diarrhea, and determine if it can be normalized by probiotic treatment.


Methods This placebo-controlled, unblinded clinical trial was performed in Budhi Asih District Hospital, Jakarta, from January to March 2018. Twenty-four children age 6-24 months with acute diarrhea and 12 healthy children were enrolled. First fecal specimen was collected for all subjects and analyzed using non-culture real time PCR to count the population of Lactobacillus, Bifidobacterium, Enterobacter, Clostridium, and all bacteria. Children with diarrhea were assigned to probiotic or placebo treatment for 5 days and the second fecal specimen was analyzed two weeks after the diarrhea subsided.


Results Prior to treatment, significant higher amounts of Lactobacillus were observed in children with acute diarrhea than in healthy controls [median (interquartile range/IR): 1.52x103 (1.22x104) vs. 6.87x10 (2.41x102), respectively; proportion in percentage (from total bacteria population): 0.044% vs. 0.003%, respectively]. However, median (IR) Clostridium was significantly higher in healthy controls than in children with acute diarrhea [2.37x102 (4.64x103) vs. 4.67 (1.50x102), respectively (P<0.05), with proportion of 0.01% vs. 0.0001%, respectively]. Children who received probiotics had significantly higher count of Bifidobacterium compared to the placebo group [1.94x104 (4.97x104) vs. 1.74x103 (2.08x107), respectively, with proportion of 0.394% vs. 0.081%, respectively].


Conclusion This pilot study do not find evidence of dysbiosis in children with acute diarrhea. Group who received probiotic had higher Bifidobacterium count compared towards those who received placebo.

Article Details

How to Cite
1.
Samsudin D, Firmansyah A, Hidayati E, Yuniar I, Karyanti M, Roeslani R. Effects of probiotic on gut microbiota in children with acute diarrhea: a pilot study. PI [Internet]. 20Mar.2020 [cited 11Aug.2020];60(2):83-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2333
Section
Pediatric Gastrohepatology
Author Biographies

Agus Firmansyah

Department of Child Health, Gastrohepatology Department, University of Indonesia Medical School

Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Eka Laksmi Hidayati

Department of Child Health, Nephrology Department, University of Indonesia Medical School

Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Irene Yuniar

Department of Child Health, Pediatric Emergency Department, University of Indonesia Medical School

Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Mulya Rahma Karyanti

Department of Child Health, Tropical Infectious Disease Department, University of Indonesia Medical School

Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Rosalina Dewi Roeslani

Department of Child Health, Perinatology Department, University of Indonesia Medical School

Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

Received 2019-10-02
Accepted 2020-03-20
Published 2020-03-20

References

1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘Levels & Trends in Child Mortality: Report 2019, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2019. [cited 1 October 2019]. Available from: https://data.unicef.org/wp-content/uploads/2019/09/UN-IGME-Child-Mortality-Report-2019.pdf
2. Badan Penelitian & Pengembangan Kesehatan, Kementerian Kesehatan RI. Riskesdas 2018. Jakarta: Kemenkes RI, 2018. p. 55.
3. Mandal A, Sahi PK. Probiotics for diarrhea in children. J Med Res Innov. 2017;1:AV5-12. DOI: 10.15419/jmri.66.
4. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence – based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59:132-52. DOI: 10.1097/MPG.0000000000000375.
5. Oliveira GLV, Leite AZ, Higuchi BS, Gonzaga MI, Mariano VS. Intestinal dysbiosis and probiotic applications in autoimmune diseases. Immunology. 2017;152:1-12. DOI: 10.1111/imm.12765.
6. Arietta MC, Stiemsma LT, Amenyogbe N, Brown EM, Finlay B. The intestinal microbiome in early life: health and disease. Front Immunol. 2014;5:427. DOI: 10.3389/fimmu.2014.00427.
7. Guarner F, Sanders ME, Eliakim R, Fedorak R, Gangl A, et al. World Gastroenterology Organization Practice Guideline. Probiotics and prebiotics. 2017 [cited 1 October 2019]. Available from: http://www.worldgastroenterology.org/guidelines/global-guidelines/probiotics-and-prebiotics/probiotics-and-prebiotics-english.
8. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhea. Cochrane Database Syst Rev. 2010;2010:CD003048. DOI: 10.1002/14651858.CD003048.pub3.
9. Sazawal S, Hiremath G, Dhingra U, Malik P, Debs S, Black RE. Efficacy of probiotics in prevention of acute diarrhea: a meta-analysis of masked, randomized, placebo-controlled trials. Lancet Infect Dis. 2006;6:374-82. DOI: https://doi.org/10.1016/S1473-3099(06)70495-9.
10. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920-4. DOI: 10.3109/00365529709011203.
11. Kadim M, Soenarto Y, Hegar B, Firmansyah A. Epidemiology of Rotavirus diarrhea in children under five: a hospital-based surveillance in Jakarta. Pediatr Indones. 2011;51:138-43. DOI: 10.14238/pi51.3.2011.138-43.
12. Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660-557. DOI: 10.2471/BLT.07.043497.
13. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287-91. DOI: https://doi.org/10.1002/pst.185.
14. Agustina R, Lukito W, Firmansyah A, Suhardjo HN, Murniati D, Bindels J. The effect of early nutritional supplementation with a mixture of probiotic, prebiotic, fiber and micronutrients in infants with acute diarrhea in Indonesia. Asia Pac J Clin Nutr. 2007;16:435-42. [cited 1 October 2019]. Available from: http://apjcn.nhri.org.tw/server/APJCN/16/3/435.pdf.
15. Hegar B, Waspada MI, Gunardi H, Vandenplas Y. A double blind randomized trial showing probiotics to be ineffective in acute diarrhea in Indonesian Children. Indian J Pediatr. 2015;82:410-4. DOI: https://doi.org/10.1007/s12098-014-1408-5.
16. Shinta K, Hartantyo, Wijayahadi N. Pengaruh probiotik pada diare akut: penelitian dengan 3 preparat probiotik. Sari Pediatri. 2011;13:89-95. [cited 1 October 2019]. Available from: http://saripediatri.org/index.php.sari-pediatri/article/view/463/401.
17. Putra IGNS, Suraatmaja S, Aryasa IKN. Effect of probiotics supplementation on acute diarrhea in infants: a randomized double blind clinical trial. Pediatr Indones. 2007;47:172-8. DOI: 10.14238/pi47.4.2007.172-8.
18. Rajagukguk S, Manopo C, Mantik M. Pengaruh pemberian probiotik dan sinbiotik pada anak dengan diare akut di RSUP Prof. Dr.R.D Kandou Manado. J e-Biomedik (eBM). 2013;1:587-91. DOI: 10.35790/ebm.1.1.2013.4591.
19. Chen SY, Tsai CN, Lee YS, Lin CY, Huang KY, Chao HC, et al. Intestinal microbiome in children with severe and complicated acute viral gastroenteritis. Sci Rep. 2017;7:46130. DOI: 10.1038/srep46130.